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ACS STOP THE BLEED^庐: Past, Present, and Future鈥攁 Special Session at the ACS Committee on Trauma (COT) 2024 Annual Meeting, March 6鈥�9, in Chicago, Illinois鈥攆eatured a sneak peek at an upcoming version of the STOP THE BLEED didactic (in-person and virtual) course and outlined opportunities for expanding the program.

More than 550 members of the central and regional COT attended the meeting, which was open to COT members only. The meeting provided updates from the Advocacy, Quality, Injury Prevention, Systems, and Education Pillars, in addition to Spotlight Discussions, which are designed to enhance collaboration and networking opportunities while serving as a conduit for feedback on targeted topics.

Since the initiative launched in 2017, the program, sometimes referred to informally as the 鈥淐PR of bleeding,鈥� has prepared more than 3.7 million individuals worldwide to control bleeding in an emergency. Ultimately, the goal of the program is to prepare every American in basic bleeding control techniques and install bleeding control kits in every public venue, including schools, community centers, and stadiums.

STOP THE BLEED Version 3

A multidisciplinary workgroup comprising 28 healthcare professionals, including representatives from emergency medical services, nursing, social work, group emergency medicine, and surgery, developed the updated didactic STOP THE BLEED course, which will be released at Clinical Congress 2024 in San Francisco, California.

鈥淲e adhered to three principles when discussing how we were going to change the slide set,鈥� said Kenji Inaba, MD, FACS, FRCSC, Chair of the ACS STOP THE BLEED Steering Committee:

• Emphasize pictures over words
• Explain basic physiology鈥攈ow do pressure, packing, and a tourniquet stop bleeding?
• Create a course that could be tailored with inserts

鈥淲e went from version 2 of the STOP THE BLEED course with more than 400 independent English words to fewer than 60 in version 3,鈥� Dr. Inaba said. The ACS commissioned an award-winning medical illustrator, who has produced design work for the Smithsonian and other notable institutions, to help develop the images in the new version.

鈥淲e took the time to design different things that would apply to injuries that would occur not just here in Chicago, but in Ukraine, Tokyo, and all around the world,鈥� explained Dr. Inaba, noting that the STOP THE BLEED course is now available in more than 150 countries. 鈥淲e鈥檙e hoping that this pictures-over-words method of teaching will make it much easier for us to export this globally.鈥�

The second guiding principle鈥攑rovide users with a brief anatomy lesson鈥攊nvolved adapting course FAQs into pictorial representations. 鈥淲e can use these pictures to explain an injury to the abdomen or the thoracic cage or a junctional injury鈥�and how those could be dealt with. We really wanted to use pictures to go over the physiology so that we know why we're doing what we're doing,鈥� Dr. Inaba said.听

Create customizable PowerPoint presentations鈥攖he third guiding principle鈥攇ives instructors the flexibility to develop a presentation that is applicable to specific geographic locations or practice types.

A key component of the version 3 rollout this fall is a revitalized branding strategy, featuring a new STOP THE BLEED logo.

鈥淚 would suspect that virtually everybody in this room has received communication from other competitors in the bleeding control space. And it is really important to distinguish ourselves from these other organizations鈥�to highlight all of the work that鈥檚 been done,鈥� Dr. Inaba said, noting that the finalized logo will be available in different colors and patterns.

Two STOP THE BLEED initiatives in development this summer include integrating the instructor slides into a main course that will replace the separate instructor module. In addition, developing requirements for participation in the ACS Safe Communities and ACS Safe Organizations initiatives will help support equipment access, prevention efforts, as well as teaching and maintenance of competency.

Advocacy in Action

鈥淲e are accelerating our progress with meaningful state action for placement of bleeding control kits in schools and public spaces,鈥� said John Armstrong, MD, FACS, Chair of the COT Advocacy Pillar. A total of 14 states have passed bleeding control legislation since this initiative started 4 years ago. These laws outlined mandates to train school nurses and staff (Arkansas); require kits in new construction (California); establish a donation pool to purchase kits for a public safety agency (Indiana); purchase kits in state-owned buildings (New Hampshire); and more.

Dr. Armstrong highlighted the most recent legislative victory that occurred in March in the state of Washington, with the passage of SB 5790 that will provide bleeding control kits in schools and support the training of bystanders.

鈥淎s our colleagues in Washington State know, the line for successful advocacy is often not linear,鈥� he said. 鈥淚t often has many twists and curves, some of which occurred earlier this week. And thanks to quick action by our colleagues in Washington with our manager of state affairs and SurgeonsVoice, the message to overwhelm what was becoming a potential defeat occurred from well over 100 surgeons in the state of Washington.鈥�

In order to achieve support by the ACS, all proposed state legislation should include requirements for placing the kits in public places, specifications outlining kit contents, requirements related to kit use and maintenance, and immunity from civil liability.

At the federal level, there are two bleeding control bills: S. 2644: The American Law Enforcement Sustaining Aid and Vital Emergency Resources (SAVER) Act, which permits the purchase of kits and supplies from an existing US Department of Justice grant fund; and S. 1653 Prevent BLEEDing Act, which establishes bleeding control kits through the Office of the Assistant Secretary for Preparedness and Response within the US Department of Health and Human Services.

鈥淲hat we have learned in Washington is there's likely no new money [to support STOP THE BLEED expansion], but we can suggest repurposing existing funds,鈥� explained Dr. Armstrong.

鈥淚 see STOP THE BLEED as a conversation starter with decision makers across our communities, local, state, and national,鈥� said Dr. Armstrong at the conclusion of his presentation. 鈥淭he way to succeed is to collaborate with state chapters, medical associations, and hospitals and to demonstrate STOP THE BLEED with our elected officials.鈥�

STOP THE BLEED Champions

鈥溾�榃e Are the Champions鈥� and 鈥楧on鈥檛 Stop Me Now鈥� are two of the greatest songs by Queen,鈥� said trauma surgeon David S. Shapiro, MD, FACS, Organization STOP THE BLEED Project Lead. 鈥淚f we are the champions, then we have to do the work to empower, inform, and educate others about the STOP THE BLEED program.鈥� He specifically called on COT state chairs and vice-chairs to take accountability for promoting local awareness of the initiative and to recruit, teach, and retain course instructors.

鈥淲hat we have to do as the chairs and vice-chairs is make sure that the course is being taught properly with the new version,鈥� said Dr. Shapiro. 鈥淭here will be some changes that are coming. The course is still providing the same information, but it's conveyed in a different way鈥攁nd we have to make sure we're doing that together.鈥�

He also urged members of the COT to collaborate with other organizations that conduct STOP THE BLEED courses鈥攕uch as the National Emergency Medical Services Information System, Society of Trauma Nurses, Emergency Nurses Association鈥攖o make sure there is alignment regarding how version 3 is taught.

鈥淥nce you get the new version, read it thoroughly,鈥� suggested Dr. Shapiro. 鈥淢ake sure folks understand it. Collaboration is important, not just across COT pillars but across organizations.鈥�

Honoring Dr. Jacobs

Lenworth M. Jacobs Jr., MD, MPH, FACS, who brought the STOP THE BLEED program to the ACS, underscored the value of credible data to achieve ongoing support for the initiative. He cited a 2023 article published by co-panelist Dr. Inaba in the American Journal of Surgery that outlines recent trends in mass shootings in the US, describing these events as a 鈥渨orsening American epidemic of death.鈥�

Dr. Jacobs provided a high-level overview of some key program milestones that led to the successful implementation of the STOP THE BLEED program, including:

• Defining a clear vision
• Engaging multiple partners
• Obtaining a national directive
• Engaging public and multiple agencies for support
• Implementing bleeding control training
• Engaging in ongoing advocacy for national and international dissemination

In acknowledgment of Dr. Jacobs鈥檚 contributions as Program Director of the STOP THE BLEED program鈥攁 role that concludes in May鈥攈e was presented with a commemorative shadow box featuring the following inscription: 鈥淭hank you for all you have done and all you continue to do on behalf of injured patients worldwide. Your visionary leadership has made the STOP THE BLEED program the overwhelming success that it is today.鈥�

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Tony Peregrin is the Managing Editor of Special Projects in the ACS Division of Integrated Communications in Chicago, IL.

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